Pain Management Coding Alert

Plus: Don’t miss the name change in the index. 

When selecting a diagnosis for reflex sympathetic dystrophy (RSD), you currently have four ICD-9 options based on the affected site. That will change when ICD-10 becomes effective in October 2015, when you’ll have more specific site choices to report as well as switch to updated terminology.  

ICD-9 coding: Diagnoses for RSD belong to the 337.2x code family, with the fifth digit noting the anatomic site. They are: 

• 337.20 – Reflex sympathetic dystrophy, unspecified
• 337.21 – Reflex sympathetic dystrophy of the upper limb
• 337.22 – Reflex sympathetic dystrophy of the lower limb
• 337.29 – Reflex sympathetic dystrophy of other specified site. This could include non-extremity sites such as the chest, breast, or abdomen. 

ICD-10 differences: Your providers will need to be more specific in their documentation once you begin coding under ICD-10. Notes of “upper” or “lower” won’t be enough to pinpoint the best code at that point – you’ll also need to know “right,” “left,” or “bilateral.” The new range of choices will be: 

• G90.50 – Complex regional pain syndrome I, unspecified 
• G90.511 – Complex regional pain syndrome I of right upper limb
• G90.512 – Complex regional pain syndrome I of left upper limb
• G90.513 – Complex regional pain syndrome I of upper limb, bilateral
• G90.521 – Complex regional pain syndrome I of right lower limb
• G90.522 – Complex regional pain syndrome I of left lower limb
• G90.523 – Complex regional pain syndrome I of lower limb, bilateral.

Note that ICD-10 also lists the condition under its other name: complex regional pain syndrome, or CRPS. CRPS Type I is the current worldwide term for this condition, replacing the old name of RSD (CRSP Type II represents causalgia). “This is a good example of one of the ICD-10 improvements: updated medical terminology and classification of diseases,” says Marvel Hammer, RN, CPC, CCS-P, ACS-PM, CPCO, owner of MJH Consulting in Denver, Co.